Kaiser Daily Global Health Policy Report

In The News

“The deaths of more than 74,000 children from tuberculosis (TB) could be prevented each year through measures outlined in the first action plan developed specifically on TB and children, which was launched [Tuesday] by the United Nations health agency in Washington, D.C.,” the U.N. News Centre reports. “The ‘Roadmap for Childhood TB: Towards Zero Deaths‘ estimates that $120 million per year could have a major impact on saving tens of thousands of children’s lives from TB, including among children infected with both TB and HIV,” the news service writes, noting, “The roadmap recommends various actions at national and global levels, including collecting and reporting better data, developing training and reference materials on childhood TB for health workers, fostering local expertise and leadership among child health workers at all levels of health systems, and developing integrated family and community-centered strategies to provide comprehensive and effective services at the community level” (10/1).

According to a joint press release from the authors of the roadmap, which include the WHO, UNICEF, CDC, and several non-governmental organizations (NGOs), $40 million of the necessary “$120 million a year in new funding for addressing TB in children from governments and donors [would go toward] HIV antiretroviral therapy and preventive therapy (to prevent active TB disease) for children co-infected with TB and HIV.” The funds would “also go towards improving detection, developing better medicines for children and integrating TB treatment into existing maternal and child health programs,” the press release states (10/1). “[B]ut it’s unclear if donors will invest; there is already a projected $21 billion shortfall for global efforts to fight TB until 2015,” the Associated Press/Huffington Post reports (10/1). “The report says there is an urgent need to focus on children,” BBC News notes, adding, “Each day almost 200 children under the age of 15 die from tuberculosis, while more than half a million fall ill every year, it says” (10/1). “Experts say tuberculosis in children — defined as people under the age of 15 — has often been overlooked because there isn’t a reliable diagnostic test and its symptoms are similar to many other childhood illnesses,” and because children are less likely to spread the disease, “it hasn’t been considered a major public health problem,” according to the AP (10/1).

On the first day of a government shutdown on Tuesday, “[USAID], the State Department and the Millennium Challenge Corp. all pledged to continue business as usual in Washington, D.C., and missions around the world for the foreseeable future, operating on residual funds and continuing to honor existing contracts and grants,” Devex reports. “The Obama administration considers USAID a national security agency,” the news service notes, adding, “In 2010, a presidential policy directive elevated development alongside defense and diplomacy and suggested the USAID administrator would be invited to join National Security Council sessions on occasion.” Devex adds, “But even though the U.S. aid apparatus appears to fare much better under this shutdown, uncertainty persists. … Industry officials this week told Devex they fear that even though U.S. aid agencies remain open, important decisions related to policy, programming and partnership will be delayed due to funding uncertainty” (Rosenkranz/Stephens, 10/2).

“Members of the Foreign Service, however, will likely see impacts if the shutdown continues, as will programs dependent on U.S. foreign aid,” Inter Press Service reports. “[I]t is clear that U.S. assistance will begin to feel shutdown-related economic pinches — or worse — if lawmakers are not able to reopen the government in the near term,” IPS writes, adding, “The first to be impacted would likely be some of the development programs that receive funding in just one-year durations.” The news service discusses the short- and long-term implications of the shutdown. “Although political pressures are quickly growing on lawmakers to arrive at a funding solution to re-open the federal government, the current situation could drag on longer than some have previously suggested,” the news service states (Biron, 10/1).

“The United Nations is shifting its aid effort for Syria to prepare for long-term help to neighboring countries to cope with the humanitarian crisis, the head of the U.N. refugee agency UNHCR said on Tuesday,” Reuters reports. “Over half of [Syria’s] 20 million people need aid and around two million have fled to neighboring Turkey, Lebanon, Jordan and Iraq,” the news agency notes. Speaking at a news conference in Geneva, UNHCR Chief Antonio Guterres said, “What we want from now is … a longer-term kind of approach, not only in relation to humanitarian aspects but in relation to structural aspects, namely related to those areas that are more directly impacted — education, health, infrastructure, housing, environment,” according to Reuters (Miles, 10/1). The New York Times notes, “At least 15 countries have agreed to set up special quotas for fugitives fleeing Syria’s civil war, marking a shift in international thinking about how to deal with the world’s biggest humanitarian crisis, [Guterres] said Tuesday.” The newspaper continues, “The countries, including the United States and many in Europe, agreed to help resettle civilians fleeing the 30-month-old conflict, [he] said.”

“Guterres said he hoped that the progress on aid would help efforts to convene a peace conference in Geneva and achieve a negotiated solution to the Syrian conflict,” the New York Times reports, adding, “The debate on providing more aid came, however, with renewed demands for international pressure on the Syrian president, Bashar al-Assad, to remove barriers to delivery of humanitarian assistance inside the country” (Cumming-Bruce, 10/1). “The president of the U.N. Security Council said Monday that many members are pressing to follow up on last week’s resolution to eliminate Syria’s chemical weapons with a demand that the government allow immediate access for desperately needed humanitarian aid,” the Associated Press/Washington Post notes (9/30). “A team of international disarmament experts has arrived in Syria to begin work on dismantling the country’s stockpile of chemical weapons,” according to BBC News (10/1).

“The world is aging so fast that most countries are not prepared to support their swelling numbers of elderly people, according to a global study … issued Tuesday by the United Nations and an elder rights group,” the Associated Press/Seattle Post-Intelligencer reports. “The report ranks the social and economic well-being of elders in 91 countries, with Sweden coming out on top and Afghanistan at the bottom,” the news agency notes (Gelineau, 10/1). “Billed as the first comprehensive collection of data on factors such as health, income and the way in which older people are empowered, the Global AgeWatch Index said most were not prepared for the challenge of ensuring a secure future for older citizens,” Deutsche Welle adds (Connor, 10/1).

“However, if appropriate measures are implemented, population aging does not inevitably lead to significantly higher health care spending, according to the report, which highlights the importance of long-term investments in education and health care for older people,” The Guardian reports (Tran, 10/1). “The index, released on the U.N.’s International Day of Older Persons, compiles data from the U.N., [WHO], World Bank and other global agencies, and analyzes income, health, education, employment and age-friendly environment in each country,” the AP writes (10/1). “The aging index is calculated using 13 indicators under four headings: income security, health care, employment and education, and an enabling environment,” The Guardian adds (10/1). The Guardian’s “Data Blog” features an interactive map showing the best and worst places to grow old (Chalabi, 9/30).

“Nearly one in five people in Africa live without frequent access to clean water, food and medical care, despite continued reports of economic growth throughout the continent, according to [a survey by] the Afrobarometer project, an independent research endeavor that measures the social, political and economic atmosphere in Africa,” Nature World News reports, noting, “The fifth edition of the Afrobarometer survey [.pdf], which is released every few years, was published Tuesday in Johannesburg, South Africa” (Foley, 10/1). “The survey results appear to contrast with the perception of ‘Africa rising,’ a continent casting off old stereotypes as growth rates touch double digits in some countries,” Agence France-Presse reports, adding, “Over half the respondents on the continent rated their country’s economy bad, while only a third thought the economy and their living conditions had improved in the past year” (10/1).

Speaking at a briefing at U.N. headquarters on the work of the African Regional Economic Communities on Tuesday, U.N. Deputy Secretary-General Jan Eliasson “stressed that the international community must address chronic humanitarian needs and crises in Africa if the continent is to achieve the Millennium Development Goals (MDGs) before their 2015 deadline,” the U.N. News Centre reports. “Africa is particularly vulnerable to the threat posed by climate change. Droughts, floods and unpredictable weather are displacing populations, devastating areas and generating competition for scarce resources that can even lead to conflict,” Eliasson said, the news service writes, adding, “Eliasson said he was particularly interested in boosting the setup of early warning and early response systems in regions, countries and communities, as they have an enormous potential to save lives” (10/1).

“Half of India’s states would be ready to roll out the federal food aid program by the end of this year, the food minister said Tuesday, as the government tries to speed up the implementation of the centerpiece of its policy agenda ahead of elections,” the Wall Street Journal reports. The country’s recently implemented food security law “guarantees the right to nearly-free rice and wheat to about 70 percent of the country’s more than 1.2 billion people, and is one of the most ambitious food aid programs ever attempted,” the newspaper notes. “The government is implementing the program at a time when the country is preparing for federal elections, which must be held by May,” according to the newspaper. “Critics [of the program] say it would impose an unbearable financial strain when the government is struggling to control its fiscal deficit, while its supporters say it would help alleviate hunger in a country that is home to a third of the world’s poor,” the Wall Street Journal writes (Mukherji, 10/1).

“Giving in the United States by private and community foundations reached an estimated $50.9 billion in 2012, growing just ahead of inflation, a report released on Tuesday by the Foundation Center showed,” Reuters reports. “In 2011 the country’s 81,777 foundations held $622 billion in assets and distributed $49 billion, just $1.9 billion below 2012’s estimate, according to the Foundation Center’s annual research study,” the news service notes. “The report shows that 35 percent of all grant dollars awarded in 2011 by the nation’s largest foundations were specifically intended to benefit the economically disadvantaged,” according to Reuters, which adds, “It also shows that health and education were the top priorities of the country’s largest foundations, accounting for almost half of all grant dollars.”

“The health sector benefited the most from foundation giving, receiving $6.8 billion, or 28 percent, of the $24.5 billion awarded in grants in 2011,” the news service continues, noting, “Education came in second, receiving $5 billion, arts and culture received $3.5 billion, tying with human services which drew $3.5 billion.” According to Reuters, “[i]n 2011, the Bill & Melinda Gates Foundation made the single largest grant of $967 million over five years to the [GAVI Alliance], according to the Foundation Center.” The news service adds, “The Gates Foundation, the largest in the country with $34.6 billion in assets, was the biggest donor in 2011 giving $3.2 billion. It has also been the top international funder since 2004” (Badawy, 10/1).

Highlighting the launch of Malaria No More’s “‘Power of One’ campaign, which links mobile phones around the world with a tracking program for malaria testing and treatment supplies, so individuals can track the impact of their charitable donations,” Devex interviews CEO Martin Edlund “about the prospects of eradicating the disease,” how “mobile technology can help overcome the ‘bad’ information that has plagued similar initiatives for decades,” and “his hopes for a robust replenishment of the Global Fund, a process already underway with major donor announcements in recent weeks.” According to the interview transcript, Edlund talks about the aims of the new campaign, challenges to the mobile platform, and what is needed at the policy level as the U.N. looks at new development goals, among other topics (Igoe, 10/2).

Editorials and Opinions

“A decade ago, the notion of beginning to end the [AIDS] epidemic was a dream. Now it has the possibility of becoming a reality,” Chris Collins, vice president and director of public policy for amfAR, The Foundation for AIDS Research, and Mitchell Warren, executive director of AVAC, write in the Huffington Post’s “Big Push” blog. “But this can only happen with sustained and increased investment. Without this, the success to date will be lost and the price tag for the AIDS response will continue to climb,” they state. “The most urgent task for donors, national governments and policy makers committed to an effective AIDS response is to focus human and financial resources on delivering high-impact, evidence-based HIV prevention and treatment at scale — reaching coverage for maximum impact,” they continue, adding, “The next stage of the fight against AIDS depends on doing the things that work now as well as possible, so that they reach everyone in need.”

“While the new UNAIDS report documents declines in new HIV infections, … we have yet to reach a global tipping point — at which the number of HIV-positive people starting treatment annually finally exceeds the number of new infections,” Collins and Warren write. “Epidemiological modeling tells us that if we wait, the possibility of tipping the scales recedes — and the price tag for the AIDS response climbs. But if we act, now, with a surge of investment, then the price of the AIDS response will go down over time,” they state. Collins and Warren highlight a progress report issued by amfAR and AVAC this week, “showing that while some critical gains have been made, the global tipping point is still years away,” and note the report makes the following recommendations for action: sustain and increase investment, make smarter and more-focused investments, and invest in new approaches and technologies (10/1).

“African government leaders meet this week in Addis Ababa, Ethiopia, to chart a forward-looking agenda building on commitments made at the landmark International Conference on Population and Development (ICPD) in Cairo in 1994,” Joaquim Chissano, former president of Mozambique and co-chair of the High Level Task Force for ICPD — a group of government, civil society, and private sector leaders working to ensure that sexual and reproductive health and rights is central to the global development agenda — writes in the Huffington Post’s “Global Motherhood” blog. “At that conference, governments placed the human rights and empowerment of women, including their reproductive health and rights, squarely at the center of population policies and sustainable development,” he notes, adding, “I know that if governments agree to uphold sexual and reproductive rights and health for all, they will also be helping Africa reduce poverty and meet its development objectives, while capitalizing on current economic growth.”

Noting “sub-Saharan Africa accounts for over half of the 800 maternal deaths that occur globally each day,” Chissano continues, “No country can afford to forgo opportunities to make sexual and reproductive health and rights a reality in the 21st century. These priorities are keys to unleashing the full energies and talents of our people, especially women and young people. They must be pillars of any sound post-2015 global development agenda.” He presents four policy recommendations “crucial for Africa’s development transformation,” including: “Enact[ing] legal and policy reforms that respect, protect and fulfill sexual and reproductive rights for all”; “[a]ccelerat[ing] universal access to quality sexual and reproductive health information, education and services”; “[g]uarantee[ing] universal access to comprehensive sexuality education for all young people, both in and out of school”; and “[e]nd[ing] violence against women and girls and impunity for perpetrators.” He concludes, “This will put us on the right path to bolster the resilience of our people and families, the vibrancy of our communities and the sustainable, inclusive growth of our nations” (9/30).

Recent Releases

In a meeting with top African and global health leaders on the sidelines of the U.N. General Assembly in New York last week, U.S. Secretary of State John Kerry “reaffirmed the U.S. government’s commitment to assist countries in realizing the promise of an AIDS-free generation and reaching their broader health goals through [PEPFAR] and the Global Fund to Fight, AIDS, Tuberculosis and Malaria,” Ambassador Eric Goosby, head of the U.S. State Department’s Office of Global Health Diplomacy and the U.S. global AIDS coordinator, writes in the State Department’s “DipNote” blog. “To further this momentum, the secretary announced the establishment of PEPFAR Country Health Partnerships,” Goosby notes, adding, “Building on the success of PEPFAR’s 22 Partnership Frameworks, PEPFAR Country Health Partnerships will advance the principle of country ownership — in which President Obama, Secretary Kerry, and I believe so strongly — by further empowering countries as they work to improve the health of their citizens and achieve an AIDS-free generation at home.” Goosby states, “Never before have we had so much momentum, such clear science to guide our way, and so many partners from various sectors driving in the same direction” (9/30).

The Senate Foreign Relations Committee on Monday night passed by voice vote an amended version of the PEPFAR Stewardship and Oversight Act, introduced last week by Sen. Robert Menendez (D-N.J.), chair of the Senate Foreign Relations Committee, and Sen. Bob Corker (R-Tenn.), the committee’s ranking member, the Center for Global Health Policy’s “Science Speaks” blog reports. The amended version included, among other things, additional reporting requirements on TB/HIV co-infection and health workforce training, according to the blog. “The committee’s action Monday night coincided with the official end date of the Lantos Hyde Act, which reauthorized [PEPFAR] for five years in 2008,” the blog notes. In the House, Reps. Ed Royce (R-Calif.) and Eliot Engel (D-N.Y.), joined by Reps. Barbara Lee (D-Calif.) and Ileana Ros-Lehtinen (R-Fla.), “last week introduced an identical bill to the one originally introduced in the Senate committee,” the blog adds (Barton, 10/1).

In a post in USAID’s “IMPACTblog,” Emmanuel Ogwuche, senior logistics adviser and manager of the agency’s Direct Delivery and Information Capture (DDIC) system, examines what it takes to deliver contraceptives to people in rural Nigeria through USAID’s Deliver Project. “Through DDIC, the project currently delivers 24 public health commodities, including contraceptives, antimalarial medications, and maternal, newborn and child health products to 365 selected service delivery points in the selected states,” Ogwuche notes, adding, “The DDIC system utilizes a vendor-managed inventory model, whereby products are delivered from state warehouses directly to the health facilities on trucks that serve as mobile warehouses.” He states, “Though still in the pilot phase, DDIC has improved the availability of contraceptives and other commodities in rural health facilities in supported states” (10/1).

The Global Fund to Fight AIDS, Tuberculosis and Malaria has published Issue 26 of its newsletter, the “Global Fund News Flash.” The issue focuses on recent commitments by the U.S. and U.K., highlights a UNAIDS report showing a decrease in the number of new HIV infections, and discusses how Bangladesh is addressing multidrug-resistant tuberculosis (TB) (9/27).